Q: We routinely use Silvadene for burn treatment at our hospital. I understand that you are not too keen on it. Why?

Posted on October 25, 2010 by & filed under , , .

Q: We routinely use Silvadene for burn treatment at our hospital. I understand that you are not too keen on it. Why?

A: We have steered away from silver sulfadiazine (e.g., Silvadene) at work for years. We have found that products like a vasoline-type gauze, e.g., Xeroform, is more comfortable and easier to maintain requiring fewer banadage changes. In a 2008, a Cochrane review of dressings for superficial and partial thickness burns noted that silver sulfadiazine delayed healing and that moist dressings seem to decrease the pain and decrease healing times.

Bottomline: Fewer, less vigorous washings with less frequent bandage changes adds up to important practical advantages.

2 Responses to “Q: We routinely use Silvadene for burn treatment at our hospital. I understand that you are not too keen on it. Why?”

RD

If you are using Xeroderm on burns instead of Silvadene, what instructions do you give patients for the care of their burns at home and how often do you follow up with them in the clinic/office setting?

Admin

Thank you for the question.

I ask them to leave the bandage in place and come back in about 24 hrs. Burns have a way of evolving so this first revisit helps to give me a better idea of the extent.

From there, it depends on what I see. Usually a once daily change will suffice. Most patients can manage this fine. If the burn blister has been completely debrided and the surface is still raw and weeping, I supplement a thin film of an antibiotic ointment on the surface of the petroleum-based gauze to help to prevent sticking. If the surface is weeping, they may have to change the bandage more frequently. Otherwise all of the bandaging will dry out and a bandage change will become more of a painful wet-to-dry debridement. This is cruel and unnecessary. The extra film can also be particularly helpful if you leave a dressing on for a couple of days, like on a trip with limited supplies.

I generally don’t have people come back unless I believe they will have difficulty managing the procedure (e.g., because of the burn location, age of the patient, extent) or are not improving over 3 – 5 days. Obviously, I encourage them to return promptly if things are worse in any way or if they have questions or concerns.

Overally this a simpler, cleaner and more comfortable approach for outpatient burn care.

David Johnson, MD

In addition to his writing, teaching, and business responsibilities with Wilderness Medical Associates, David (DJ) also works as an Emergency Physician at Central Maine Medical Center in Lewiston, Maine His outdoor pursuits have included wilderness...